Spontaneous pneumothorax and pneumomediastinum as a rare complication of COVID-19 pneumonia: Report of 6 cases

Rafiee, Moezedin Javad; Fard, Faranak Babaki; Samimi, Kaveh; Rasti, Hamid; Pressacco, Joséphine

doi:10.1016/j.radcr.2021.01.011

Cited by 22 publications

(25 citation statements)

References 20 publications

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“…Due to the vague nature of presenting symptoms [5] , imaging is essential to make a diagnosis of pneumomediastinum and should be considered in all COVID-19 patients with unexplained clinical deterioration [ 36 , 37 ]. Chest X-ray is the first imaging modality employed and often suggests the diagnosis by showing linear or curvilinear lucencies outlining mediastinal contours.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Kalpaxi

Kalokairinou

Katseli

et al. 2021

Radiology Case Reports

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Spontaneous pneumomediastinum (SPM) is a rare complication of coronavirus disease 2019 (COVID-19). The published literature consists mainly of case reports and small case series. There are still many questions regarding the pathogenesis, the prognostic significance and the implications on patient management. In our hospital three COVID-19 patients developed SPM: one on admission at the emergency department and the other two during hospitalization. In this study we describe their clinical course and computed tomography (CT) findings. All of them had severe disease according to the total severity score on admission CT. The management of pneumomediastinum was conservative and follow-up CT showed resolution in all patients. As the correlation between extension of parenchymal lung lesions and development of pneumomediastinum is still under investigation, we highlight the importance of reporting the severity score on chest CT in order to obtain more comparable results between different studies. Furthermore, in this tragic circumstance we also had the opportunity to familiarize ourselves with the otherwise uncommon occurrence of air along the bronchovascular sheaths (Macklin effect) and evaluate the ability of CT to detect it.

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Section: Discussionmentioning

confidence: 99%

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Kalpaxi

Kalokairinou

Katseli

et al. 2021

Radiology Case Reports

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“…1 ). Articles and case descriptions with as much information as possible were selected for analysis; therefore, not all case studies were selected [ [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] ...…”

Section: Methodsmentioning

confidence: 99%

Pneumothorax due to COVID-19: Analysis of case reports

Gaytán¹,

Andrade²,

Valenzo³

2021

Respiratory Medicine Case Reports

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Cases of pneumothorax/pneumomediastinum have been reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); however, the time to onset and hospital stay have rarely been studied. Coronavirus disease 2019 (COVID-19) patients with these complications are described to determine the time to onset, associated comorbidities, and location and duration of pneumothorax. A search in PubMed yielded simple frequencies and a bivariate analysis of deaths. There were 113 confirmed cases in 67 articles. The median time from the date of hospital admission to the presence of pneumothorax was 8 days. Right hemithorax was the most frequent form of pneumothorax. Almost half of the patients required intubation for invasive mechanical ventilation. Although the frequency of this phenomenon was not high among hospitalized patients with confirmed SARS-CoV-2, it was high among those who developed acute respiratory distress syndrome (ARDS). This study contributes to the literature because it presents a large number of patients who developed pneumothorax after admission, which was characterized by clinical deterioration (dyspnea, tachypnea, pleuritic chest pain, and subcutaneous emphysema) and low oxygen saturation levels. Pneumothorax/pneumomediastinum is recommended as a differential diagnosis, even without considering the presence of chronic pulmonary comorbidities or invasive mechanical ventilation.

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“…RT-PCR is, however, prone to a number of limitations, i.e., besides being time consuming, it is associated with high false-negative rate in different clinical samples 2 . Due to high sensitivity and rapid access, chest computed tomography (CT) scan has been the main imaging modality for diagnosis, prognostic assessment, and detection of complications of COVID-19 3,4 . The most common manifestations of COVID-19 pneumonia in chest CT scan are multifocal ground-glass opacities (GGO) with or without consolidative areas, predominantly having peripheral, lower-lobes, and posterior anatomic distribution 3,4 .…”

Section: Mainmentioning

confidence: 99%

Human-level COVID-19 Diagnosis from Low-dose CT Scans Using a Two-stage Time-distributed Capsule Network

Afshar¹,

Rafiee²,

Naderkhani³

et al. 2021

Preprint

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Reverse transcription-polymerase chain reaction (RT-PCR) is currently the gold standard in COVID-19 diagnosis. It can, however, take days to provide the diagnosis, and false negative rate is relatively high. Imaging, in particular chest computed tomography (CT), can assist with diagnosis and assessment of this disease. Nevertheless, it is shown that standard dose CT scan gives significant radiation burden to patients, especially those in need of multiple scans. In this study, we consider low-dose and ultra-low-dose (LDCT and ULDCT) scan protocols that reduce the radiation exposure close to that of a single X-Ray, while maintaining an acceptable resolution for diagnosis purposes. Since thoracic radiology expertise may not be widely available during the pandemic, we develop an Artificial Intelligence (AI)-based framework using a collected dataset of LDCT/ULDCT scans, to study the hypothesis that the AI model can provide human-level performance. The AI model uses a two stage capsule network architecture and can rapidly classify COVID-19, community acquired pneumonia (CAP), and normal cases, using LDCT/ULDCT scans. The AI model achieves COVID-19 sensitivity of 89.5% ± 0.11, CAP sensitivity of 95% ± 0.11, normal cases sensitivity (specificity) of 85.7% ± 0.16, and accuracy of 90% ± 0.06. By incorporating clinical data (demographic and symptoms), the performance further improves to COVID-19 sensitivity of 94.3% ± 0.05, CAP sensitivity of 96.7% ± 0.07, normal cases sensitivity (specificity) of 91% ± 0.09 , and accuracy of 94.1% ± 0.03. The proposed AI model achieves human-level diagnosis based on the LDCT/ULDCT scans with reduced radiation exposure. We believe that the proposed AI model has the potential to assist the radiologists to accurately and promptly diagnose COVID-19 infection and help control the transmission chain during the pandemic.

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Spontaneous pneumothorax and pneumomediastinum as a rare complication of COVID-19 pneumonia: Report of 6 cases

Cited by 22 publications

References 20 publications

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Spontaneous pneumomediastinum and COVID-19 pneumonia: Report of three cases with emphasis on CT imaging

Pneumothorax due to COVID-19: Analysis of case reports

Human-level COVID-19 Diagnosis from Low-dose CT Scans Using a Two-stage Time-distributed Capsule Network

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